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ACCIDENT WAIVER, RELEASE OF LIABILITY AND PHOTO RELEASE FORM

WE PROVIDE ECONOMICALLY AND CULTURALLY DISADVANTAGED YOUTH WITH THE BELONGING AND PURPOSE THEY NEED TO GROW AND REINVEST IN THEIR COMMUNITY.

We create more skilled, supported, connected communities through subcultures — skateboarding, music, and art.

 

YOU MUST BE 19 YEARS OR OLDER TO COMPLETE THIS FORM. IF YOU ARE UNDER 19, PLEASE HAVE A PARENT OR LEGAL GUARDIAN ASSIST. 

 

We offer a number of on-site and off-site programs and activities that support our mission, including, but not limited to: The Bay skateparks; Skate School; day camps; Good Living Camp; private lessons; group lessons; after school and out of school time programs; esports; fashion; contests; music events; Skate for Change outings; Rabble Media events, publications and gatherings; distribution of skateboards, components and protective gear; Bay High; workforce development; virtual art engagement; virtual music engagement; virtual skate engagement; and online communities (each and collectively, the “Program”). In order to participate in the Program, each participant or their parent or legal guardian must submit a completed Accident Waiver, Release of Liability and Photo Release Form (this “Form”). This Form will be used by the Program Administrators and will govern your actions and responsibilities during the Program. To ensure that you understand and accept the risk of participation, you must indicate your understanding and agreement by signing on the appropriate lines below. Participants who have not completed this Form will not be permitted to participate in any activities; however, no participant shall be obligated to participate in any particular activity. Please note that certain Program partners may require you to execute additional waiver and consent forms in order to participate in specific activities. 

 

In consideration of being allowed to enter the skatepark and/or participate in any Program, the undersigned, on his or her behalf, and on the behalf of the undersigned minor child(ren) identified below, acknowledges, appreciates and agrees as follows:

 

EXPRESS ASSUMPTION OF RISK ASSOCIATED WITH RECREATIONAL ACTIVITIES. I UNDERSTAND AND AGREE THAT PARTICIPATION IN THE PROGRAM IS VOLUNTARY. I FURTHER UNDERSTAND AND AGREE THAT PARTICIPATION IN THE PROGRAM IS AT MY OWN RISK AND THAT THE PROGRAM ADMINISTRATORS (AS DEFINED BELOW) ARE NOT RESPONSIBLE FOR ANY INCIDENTS, INJURIES OR LOSS OF PROPERTY THAT MAY OCCUR. I affirm that participation in the Program is entirely voluntary, and understand that participation in the Program involves a risk of injury due to certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATION IN THE PROGRAM, including, by way of example and not limitation, the following: any risks that may arise from negligence or carelessness on the part of the Program Administrators or any other persons or entities being released or because of their possible liability without fault; any risks or injuries associated with dangerous or defective equipment or property owned, maintained, or controlled by Program Administrators; head injury; slips; falls; contact with other participants; contact with the floor, walls, ramps, goals, posts or any other equipment which may be part of certain activities; negligent or wanton acts of other participants; any defects or condition of the premises; strenuous exertions, quick movements, changes of speed, and any other activity that may place stress on the cardiovascular, muscular, and skeletal systems. I UNDERSTAND THAT PROTECTIVE HEADGEAR, SUCH AS A PROPERLY FITTED HELMET, IS STRONGLY RECOMMENDED IN ORDER TO REDUCE THE RISK OF SERIOUS HEAD INJURY ASSOCIATED WITH THE HAZARDOUS ACTIVITY AND THAT ANY REFUSAL TO UTILIZE SUCH PROTECTIVE EQUIPMENT IS DONE SOLELY AT MY OWN RISK. 

 

DECLARATION OF FITNESS. I certify that I am physically able, have sufficiently prepared or trained for participation in the Program, and have not been advised not to participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in the Program and that I will opt out of any particular activity or event for which this is not the case. I understand that the Program Administrators do not have dedicated medical personnel available on-site. In the event of illness or injury arising out of my participation in the Program, I hereby consent to and authorize (1) the administration of emergency first aid care and treatment at the scene of an emergency by Program Administrators; (2) the administration of any treatment deemed necessary by a licensed physician or dentist; and (3) the transfer to any hospital reasonably accessible. 

 

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT. In consideration of my application and for permitting me to participate in the Program, I hereby take the actions noted below for myself, my executors, administrators, heirs, next of kin, successors, and assigns vis-à-vis the following ENTITIES OR PERSONS: Victory Ride Skatepark dba The Bay; Skate for Change; Hear Nebraska; Rabble Media dba Rabble; The Bay Online; Rabble Mill; each of their respective directors, officers, employees, volunteers, representatives, and agents; the activity or event holders, activity or event sponsors, and activity or event volunteers (the “Program Administrators”). 

(A) I WAIVE, RELEASE, AND DISCHARGE the Program Administrators and any other aforementioned entities or persons from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from the Program;

 

(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the Program Administrators and any other aforementioned entities or persons from any and all liabilities or claims made as a result of participation in the Program, whether caused by negligence or otherwise. 

 

Notwithstanding anything in the foregoing to the contrary, nothing in this Form excludes or limits the liability of the Program Administrators for: (a) death or personal injury caused by their gross negligence or willful misconduct; or (b) fraud or fraudulent misrepresentation. 

 

I understand that the best way to ensure I remain safe and avoid injury is to follow the rules, regulations and instructions of the Program Administrators. I agree that I will learn and obey all relevant rules and regulations and will follow all instructions of the Program Administrators. 

 

I acknowledge that certain aspects of the Program may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, wildlife, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, Program Administrators, participants, volunteers, spectators, coaches, event officials, event monitors, and/or producers of the event, as well as dehydration. 

 

PHOTO AND VIDEO RELEASE. I understand that Program participants may be photographed or videotaped while participating in the Program. I give my consent and permission for both internal and external use of such photographs and/or videos, including for purposes of advertising, marketing, public relations or any other purpose by the Program Administrators, and hereby waive any rights of compensation for such use. I agree that all negatives and positives, whether prints, video, film or data files, are the property of the Program Administrators, or the individual or entity so designated.

 

This Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. 

 

I CERTIFY THAT I HAVE CAREFULLY READ THIS ENTIRE DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY, EMERGENCY MEDICAL AUTHORIZATION AND A CONTRACT. I SIGN THIS FORM OF MY OWN FREE WILL AND AGREE TO BE LEGALLY BOUND BY IT.


Please select who will be participating...
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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
ADDITIONAL MEDICAL NOTES

Please add any relevant medical information that EMS should be aware of, in the event that they need to provide care to you or your child.
The following questions will help The Bay use the most respectful language when addressing you/the participant, understand our population better, and fulfill our grant reporting requirements.
Participant's Preferred Pronoun*
He/Him
She/Her
They/Their
Ze
A Pronoun Not Listed
No Pronoun Preference
Prefer Not to Say
Preferred Pronoun Unknown
Participant's Gender Identity (select all that apply) *
Female/Woman
Gender Fluid
Genderqueer/Non-Binary
Intersex
Male/Man
Trans
An Identity Not Listed
Prefer Not to Say
Gender Identity Unknown
Participant's Race*
Asian
Black and/or African American
Native American/Alaska Native
Pacific Islander
White/Caucasian
Bi-Racial
Multi-Racial
My Race Is Not Listed
Prefer Not To Say
Race Unknown
Participant's Ethnicity (select all that apply) *
Cuban
Dominican
Mexican/Chicano/a
Non-Hispanic/Latino
Puerto Rican
Other Hispanic/Latino
Prefer Not to Say
Ethnicity Unknown

What school do you/the participant attend? If you/the participant do not attend school, please type "none". *
Does the participant qualify for free or reduced lunch at school?*
No
Yes
Unknown/Prefer Not to Answer
Is the participant involved in the juvenile justice system?*
No
Yes
Unknown/Prefer Not to Answer
FOR PARTICIPANTS OF MINORITY AGE (19 or under): THIS IS TO CERTIFY THAT I, AS PARENT, GUARDIAN, OR TEMPORARY GUARDIAN WITH LEGAL RESPONSIBILITY FOR THE PARTICIPANT NAMED ABOVE, DO CONSENT AND AGREE NOT ONLY TO HIS/HER RELEASE OF ALL PROGRAM ADMINISTRATORS AND RELEASEES, BUT ALSO TO RELEASE AND INDEMNIFY THE RELEASEES FROM ANY AND ALL LIABILITIES INCIDENT TO HIS/HER INVOLVEMENT IN THESE PROGRAMS FOR MYSELF, MY HEIRS, ASSIGNS, AND NEXT OF KIN.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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